DESCRIPTION: (adapted from the application) Patients and providers bring to their medical encounters their own concerns, questions and requests, which in many instances, differ. There is growing evidence that when providers explicitly acknowledge, explore and reconcile these differences with their patients, both the process and outcomes of care are improved. When patients believe that providers understand the reasons for their visits and when mutual agreement can be reached about how to spend visit time, patient satisfaction and health outcomes improve. However, such understanding requires that providers fully elicit patients? reasons for a visit. Providers cite time pressures as a major obstacle to full problem elicitation and collaborative agenda setting, and indeed, there is evidence that when providers attempt to address the full range of elicited patient concerns, visits are longer. We plan to implement and comprehensively evaluate a piloted educational intervention. The Establishing Focus protocol (EF), in a community-based primary care network to train providers in the skills needed to provide high quality care in a time-limited encounter. EF was designed to improve providers? skills related to relationship building, agenda setting, shared decision-making and time management. We propose a randomized controlled pretest-posttest design using both qualitative and quantitative outcome measures to examine the effects of EF training on: 1) the behaviors, skills, and attitudes of community practice providers, and 2) the health outcomes, functional status, and attitudes of patients. This study is the first large-scale randomized trial of an educational intervention (EF) to improve essential elements of provider patient communication, as delineated in the Kalamazoo Consensus statement. This research will fill a gap in evidence-based communications research by providing experimental evidence that a desired skill set can be taught and retained and that it will positively influence healthcare outcomes. EF training has enormous potential for improving the quality of ambulatory care, including better health outcomes and patient and provider satisfaction, at a modest, non-recurring cost. If successful, it should be easily disseminated into many practice settings as well as incorporated into professional training.